The Mental Capacity Act Flashcards
What is stage 1 of the two stage test?
Is there is impairment or disturbance in the functioning of the person’s mind or brain?
What happens if the answer to stage 1 is yes?
The person’s ability to make the decision at hand should be tested to establish whether the impairment or disturbance is sufficient to undermine the person’s capacity to make that particular decision.
What is stage 2 of the two stage test?
- Is the person able to understand the information relevant to the decision?
- Are they able to retain the information relevant to the decision?
- Are they able to use or weigh the information to reach a decision?
- Are they able to communicate the decision by any means?
A negative answer to any is failure of the test.
If the patient has been judged to lack capacity who decides for them?
There is legal permission for a doctor to make decisions on their behalf, but a legal duty to make decisions that are in the best interests of the patient.
Someone with a lasting power of attorney may also make decisions on the patient’s behalf.
Who does not automatically have the right to make decisions for the patient who lacks capacity?
Close friends or relatives
When should capacity be assessed?
Before carrying out any care or treatment - the more serious the decision the more formal the assessment should be.
What is capacity specific to?
Time and decision - a person can have the capacity to make one decision but not another, or capacity to make a decision at one time or not another.
What sort of condition might cause capacity to be variable?
High fever
What sort of condition would cause a person to permanently lack capacity?
Persistent vegetative state
What sort of condition may cause someone to have the capacity to make certain decisions but not others?
Dementia
‘Anything done for or on behalf of a person who lacks mental capacity must be done in their best interests’
What is the exception to this statement?
If a valid and applicable advance decision to refuse treatment is available. This directive must be followed whether or not it is considered to be in the best interests of the patients.
According to the MCA, what criteria must be fulfilled when assessing a persons’ best interests?
a) The persons’ past and present wishes and feelings (and in particular, any relevant written statement made by them when they have capacity).
b) The beliefs and values that would be likely to influence his decision if he had capacity, and
c) The other factors that he would be likely to consider if he were able to do so.
You should also
- encourage participation
- avoid discrimination
- assess whether the person will regain capacity
- consult other people (close friends, carers, family, LPAs etc)
Why is a best interests judgement not a ‘substitute judgement’?
It is not an attempt to determine what the person would have decided if they were able. Rather it is an objective test of what is in the person’s actual best interests. However while you are not legally bound to do what the person may or would have wanted, their views and wishes are of great significance.
What is important about the information relevant to the decision?
- It must be given in a way that is appropriate to the person’s circumstances.
- It also must include information about the reasonably foreseeable consequences of deciding one way or another or failing to make the decision.
What is the least restrictive option?
The option that interferes the least with a person’s rights or freedoms of actions, or whether there is any need to decide or act at all.
Give an example where the least restrictive option may not be in the best interests of the person in question?
A person is unconscious following a severe RTC and a decision regarding the amputation of a limb needs to be taken. It may be possible to delay amputation until the person recovers consciousness (least restrictive) but if the person is trapped and cannot be freed to have other medical treatment then it may be in their best interests to amputate.
What is a Lasting Power of Attorney (LPA)?
The MCA allows a person of 18 years or over to choose someone (also over 18) they trust to make decisions on their behalf if, sometime in the future, they loose capacity or do not wish to make those decisions for themselves
What are the two types of LPA?
- Property and financial affairs LPA.
2. Health and welfare LPA